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Mindfulness-Based Attention Training Improves Cognitive and Affective Processes in Daily Life in Remitted Patients with Recurrent Depression: A Randomized Controlled Trial

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Received: December 14, 2017 Accepted: March 27, 2018 Published online: May 16, 2018 Issue release date: June 2018

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... More recently, Ambulatory Assessment (AA) research using intensive longitudinal assessments during daily life has been suggested to be particularly suitable to identify possible mechanisms of action of mindfulness on mental health outcomes (Enkema et al., 2020). In this context, Timm et al. (2018) showed that a 4-week mindfulness-based training in patients with remitted depression significantly reduced momentary rumination in daily life. The MBCT vulnerability model (Segal et al., 2018) proposes rumination as a key mechanism triggering depressive relapses in patients with recurrent lifetime episodes and emphasizes that MBCT is particularly effective in reducing ruminative thinking cycles in these patients. ...
... The MBCT vulnerability model (Segal et al., 2018) proposes rumination as a key mechanism triggering depressive relapses in patients with recurrent lifetime episodes and emphasizes that MBCT is particularly effective in reducing ruminative thinking cycles in these patients. In accordance with this model, the intervention by Timm et al. (2018) was particularly effective in reducing daily life rumination in patients with more frequent episodes. ...
... Momentary rumination was captured with the item "At the moment, I am stuck on negative thoughts and cannot disengage from them," and selfacceptance was assessed with the item "At the moment, I accept myself as I am." These items were rated on Likert scales ranging from 1 to 7. All AA variables used in the present study have been tested extensively in previous AA studies and have shown high sensitivity to change (e.g., Beddig et al., 2019;Beddig & Kuehner, 2020;Kuehner et al., 2017;Timm et al., 2018;Wilhelm & Schoebi, 2007). ...
Article
Rumination has been proposed as an important risk factor for depression, whereas mindful attention is considered a protective form of self-focusing. Experimental studies have demonstrated differential effects of these modes when induced in the lab. However, their impact on daily life processes is poorly understood, particularly in individuals vulnerable to depressive relapses. The aim of our study was to examine short- and longer-term effects of repeated brief rumination and mindful self-focus inductions during daily life on momentary mood, cognitions, and cortisol in patients with remitted depression (rMDD) as well as in healthy individuals, and to identify their potential differential effects in these groups. The study involved repeated short ambulatory inductions of a ruminative or a mindful self-focus during daily life with additional assessments of momentary mood, rumination, self-acceptance, and cortisol over 4 consecutive days in a sample of patients with rMDD (n = 32, ≥2 lifetime episodes, age 19-55 years) and matched healthy controls (n = 32, age 21-54 years). Multilevel models revealed differential immediate effects of the two induction modes on all momentary mood and cognitive outcomes (all p's < .001), but not on cortisol. Detrimental effects of rumination over mindful self-focus inductions were particularly strong for cognitions in the patient group. Longer-term effects of the inductions over the day were lacking. This study underlines immediate deteriorating effects of an induced ruminative compared to a mindful self-focus on momentary mood and cognitions during daily life in patients with rMDD and in healthy individuals. The observed stronger rumination-related reactivity in patients suggests heightened cognitive vulnerability. Understanding rumination- and mindfulness-based mechanisms of action in real-life settings can help to establish mechanism-based treatment options for relapse prevention in depression.
... participants rMDD patients and matched healthy controls were recruited between October 2019 and October 2021 via online advertisement on the home page of the Central Institute of Mental Health (CIMH; Mannheim, Germany), and via print flyers and social media (Facebook, Twitter, various Whats-app groups). Furthermore, a subgroup of the rMDD patients (n = 46) had already taken part in a former study (Timm et al., 2018) and were recontacted for a 5-year follow-up. ...
... At each assessment point, participants rated their current mood on 7-point Likert scales ranging from 1 (not at all) to 7 (fully agree) on 12 items that were balanced in valence (i.e., positive and negative) and arousal (i.e., the degree of activation). These items were derived from the Positive and Negative Affect Schedule (PANAS; Watson et al., 1988) and from previous EMA studies (e.g., Beddig et al., 2019Beddig et al., , 2020aBeddig et al., , 2020bKuehner et al., 2017;Timm et al., 2017Timm et al., , 2018. For PA, participants were asked how "cheerful," "energetic," "enthusiastic," "satisfied," "relaxed," and "calm" they felt, and for NA how "upset," "irritated," "nervous," "listless," "down," and "bored" they felt at the moment. ...
... Rumination was assessed on a 7-point Likert scale ranging from 1 (not at all) to 7 (fully agree) with the item "At the moment before the beep, I was stuck on negative thoughts and could not disengage from them," thereby capturing the uncontrollability facet of rumination (cf. Beddig et al., 2019Beddig et al., , 2020aBeddig et al., , 2020bKuehner et al., 2017;Timm et al., 2017Timm et al., , 2018. ...
Article
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Major Depressive Disorder is a recurrent condition. Potential risk factors for future episodes are maladaptive cognitions such as rumination and unfavorable reactivity toward negative daily events. Positive thoughts and positive daily events, in contrast, could act as a buffer against mood deterioration. The aim of the present study is (1) to examine differences in daily affect and cognitions in remitted depressed patients with a history of recurrent episodes (rMDD) and healthy controls, (2) to analyse reciprocal prospective effects of momentary cognitions and affect and (3) to investigate effects of daily events on affect and cognitions in both groups. A sample of N = 102 participants underwent an Ecological Momentary Assessment (EMA) phase of five consecutive days, where rMDD patients (n = 51) and healthy controls (n = 51) indicated their momentary rumination, positive thoughts, affect and the occurrence of daily events ten times per day. Via multilevel lag models, we found higher rumination to predict a decrease of positive affect (PA) in the rMDD group, but no effect of rumination on subsequent negative affect (NA) in either group. Higher positive thoughts predicted an increase in PA and a decrease in NA, similarly strong in both groups. Regarding daily events, rMDD patients reported a stronger increase in NA and rumination following negative daily events compared to controls, whereas an observed subsequent decrease of PA and positive thoughts was not moderated by group. Following positive daily events, rMDD patients showed a stronger increase in PA and positive thoughts and a stronger decrease in NA and rumination than controls. For interventions targeting relapse prevention, our results indicate the implementation of strategies fostering the responsiveness to positive events and the up-regulation of positive affect.
... Naturally occurring NA was in turn found to be followed by increased levels of rumination, suggesting a reciprocal relation between these two constructs (Moberly & Watkins, 2008). Furthermore, effects of momentary cognitive processes on positive emotions have been documented in the context of mindfulness (Garland, Geschwind, Peeters, & Wichers, 2015;Jimenez, Niles, & Park, 2010;Timm et al., 2018;Welz, Reinhard, Alpers, & Kuehner, 2018). There is evidence that dispositional mindfulness is associated with higher levels of positive emotions and selfacceptance during daily life (Jimenez et al., 2010), and a recent study by Timm et al. (2018) demonstrated that mindfulness training led to improved positive affect (PA) and self-acceptance in remitted depressed patients, whereas NA and rumination decreased. ...
... Furthermore, effects of momentary cognitive processes on positive emotions have been documented in the context of mindfulness (Garland, Geschwind, Peeters, & Wichers, 2015;Jimenez, Niles, & Park, 2010;Timm et al., 2018;Welz, Reinhard, Alpers, & Kuehner, 2018). There is evidence that dispositional mindfulness is associated with higher levels of positive emotions and selfacceptance during daily life (Jimenez et al., 2010), and a recent study by Timm et al. (2018) demonstrated that mindfulness training led to improved positive affect (PA) and self-acceptance in remitted depressed patients, whereas NA and rumination decreased. Following these findings, rumination and NA as well as self-acceptance and PA appear to be tightly linked in daily life. ...
... For NA, participants were asked to rate how upset, irritated, nervous, listless, down and bored they felt and for PA how cheerful, energetic, enthusiastic, satisfied, relaxed and calm they felt. These items were derived from the Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) and have been used in previous EMA-studies (Kuehner, Welz, Reinhard, & Alpers, 2017;Timm et al., 2018;Welz et al., 2018). ...
Article
Premenstrual Dysphoric Disorder (PMDD) is characterized by cyclical mood changes resulting in clinically significant distress and functional impairment. Studies on momentary cognitive and affective states and their interplay during daily life over the menstrual cycle in affected women are still lacking. Using Ecological Momentary Assessment with electronic diaries, 61 women with current PMDD and 61 healthy control women reported their current mood, rumination, and self-acceptance eight times a day over two consecutive days per cycle phase (menstrual, follicular, ovulatory, and late luteal phase). Results revealed that women with PMDD showed significant increases in negative affect and rumination and decreases in positive affect and self-acceptance toward the end of the cycle. Lagged analyses demonstrated stronger within-person reciprocal effects of cognitions and mood in PMDD women compared to controls with the effect of rumination on subsequent negative affect being limited to the late luteal phase. Identified stronger prospective associations between cognitive processes and mood deteriorations in women with PMDD suggest that affected women are more sensitive to detrimental effects of either dimension. Hence, therapeutic strategies aiming at reducing ruminative thoughts and improving self-acceptance such as mindfulness-based interventions could be promising for reducing the burden of PMDD.
... These processes are particularly impaired in depression and appear to be linked to self-focused rumination during daily life (cf. Timm et al., 2018). We previously reported from this study that MBAT was clearly superior to PMR regarding improvements in momentary negative affect, rumination, and other subjective states during daily life (Timm et al., 2018). ...
... Timm et al., 2018). We previously reported from this study that MBAT was clearly superior to PMR regarding improvements in momentary negative affect, rumination, and other subjective states during daily life (Timm et al., 2018). The first aim of the present investigation was to examine possible effects of MBAT versus PMR on changes in CAR, daily slope, and total cortisol during treatment. ...
... The overall AA-response rate for the subjective ratings was 82.2 % (cf. Timm et al., 2018). The overall compliance for cortisol assessments reached 87.5 % (2867 of possible 3276 (7*6*78) probes were delivered). ...
Article
Major Depression is a stress-related disorder characterized by altered hypothalamic-pituitary-adrenal axis function. Mindfulness-based interventions have shown to improve subjective parameters of stress and to reduce relapse rates in depressed patients. However, research on their effects on diurnal patterns of cortisol and associations with subjective outcomes is lacking. The present Ambulatory Assessment study investigated possible changes in daily rhythm cortisol parameters (cortisol awakening response (CAR), daily slope, total cortisol) in currently remitted individuals with recurrent depression who were randomized to a four-week mindfulness-based focused attention training (MBAT, n = 39) or a progressive muscle relaxation training (PMR, n = 39). A second aim was to investigate whether changes in cortisol were linked to improvements in affective and cognitive daily life states. On three weekdays before and after the intervention, seven saliva cortisol samples per day were collected. For analysis, multilevel models were applied. Results revealed no group-specific or general change in CAR and daily slopes from pre- to postintervention. In contrast, total cortisol increased across groups, which was however moderated by group and subjective improvement status. While cortisol increased irrespective of subjective improvement in PMR participants, MBAT participants with larger reductions in negative affect and rumination maintained their initial cortisol levels, whereas those with lower improvement paralleled the PMR group. Thereby, MBAT appeared to buffer an increase in overall cortisol secretion over time, but only in patients showing marked improvements in those affective and cognitive states that constitute core elements for depressive relapses in the vulnerability model of mindfulness-based cognitive therapy.
... MBCT was proven effective for depression and could improve the response rate in pharmacotherapy (Eisendrath et al., 2016). Furthermore, a randomized controlled trial showed that affective processes in remitted depressed patients improved after mindfulness training (Timm et al., 2018). Although the MBCT has been proven effective in depressive symptoms, few studies have focused on the efficacy of the MBCT for emotion recognition in depressed aged. ...
... A previous study found that reports of increased experience of positive emotions were related to MBCT (van der Velden et al., 2015). In contrast to progressive muscle relaxation, PA increased and NA decreased after four weeks of mindfulness training (Timm et al., 2018). MBCT has been shown to have emotion regulation effects in many studies, including boosting the positive mood (Hofmann et al., 2010;Goyal et al., 2014) and decreasing the negative mood (Jha et al., 2010). ...
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Facial emotion recognition plays an important role in social functioning. Patients with late-life depression (LLD) often have abnormal facial emotion recognition. Mindfulness-based cognitive therapy (MBCT) is beneficial in treating depression. This study examined whether MBCT can act as an effective augmentation of antidepressants and improve facial emotion recognition in patients with LLD and its underlying neural mechanism. Patients with LLD were randomized into two groups (n = 30 per group). The MBCT group received an eight-week MBCT in conjunction with stable medication treatment. The other group was treated as usual (TAU group) with stable medication treatment. The positive affect (PA) scale, negative affect (NA) scale, and facial emotion recognition task with an fMRI scan were performed before and after the trial. After eight weeks of treatment, the repeated ANOVA showed that the PA score in the MBCT group significantly increased [F(1,54) = 13.31, p = 0.001], but did not change significantly [F(1,54) = 0.58, p = 0.449] in the TAU group. The NA scores decreased significantly in both the MBCT group [F(1,54) = 19.01, p < 0.001] and the TAU group [F(1,54) = 16.16, p < 0.001]. Patients showed an increase in recognition accuracy and speed of angry and sad faces after 8 weeks of MBCT. No improvement was detected in the TAU group after treatment. A significant interaction effect was found in the change of activation of the left superior temporal gyrus (L-STG) to negative emotional expression between time and groups. Furthermore, a decrease in activation of L-STG to negative emotional expression was positively correlated with the increase in PA score. The MBCT is beneficial for improving affect status and facial emotion recognition in patients with LLD, and the L-STG is involved in this process.
... 1 Momentary NA and PA were assessed with 12 items based on the Positive and Negative Affect Schedule (PANAS; Watson et al., 1988) and previous AA studies (e.g. Kuehner et al., 2017;Timm et al., 2018) which were collapsed according to the circumplex model of affect (Russell, 1980) and in line with Nezlek (2005) and Hoyt et al. (2015) into NA high (upset, irritated, nervous, Cronbach's alpha = 0.80), NA low (listless, down, bored, α = 0.73), PA high (cheerful, energetic, enthusiastic, α = 0.80), and PA low (content, calm, relaxed, α = 0.88) items. Outcomes were calculated by averaging the respective item scores, ranging from 1 (not at all) to 7 (very much). 2 Momentary rumination was measured with the item "right before the beep I was stuck on negative thoughts and could not disengage from them" (range 1-7, cf. ...
... Outcomes were calculated by averaging the respective item scores, ranging from 1 (not at all) to 7 (very much). 2 Momentary rumination was measured with the item "right before the beep I was stuck on negative thoughts and could not disengage from them" (range 1-7, cf. Kuehner, 2017;Timm et al., 2018). 3 Recent event-related stress was conceptualized in terms of subjective appraisals of events that continually occur in the natural flow of daily life. ...
Article
Premenstrual Dysphoric Disorder (PMDD) is characterized by significant emotional, physical and behavioral distress during the late luteal phase that remits after menses onset. Outlined as a new diagnostic category in DSM-5, the mechanisms underlying PMDD are still insufficiently known. Previous research suggests that PMDD exacerbates with stressful events, indicating a dysregulation of the hypothalamic-pituitary-adrenal axis. However, studies measuring stress-related processes in affected women in real-time and real-life are lacking. We conducted an Ambulatory Assessment (AA) study to compare subjective stress reactivity together with basal and stress-reactive cortisol activity across the menstrual cycle in women with and without PMDD. Women with current PMDD (n = 61) and age- and education matched controls (n = 61) reported momentary mood, rumination, and daily events via smartphones at semi-random time points 8 times a day over two consecutive days per cycle phase (menstrual, follicular, ovulatory, and late luteal). Twenty minutes after assessments participants collected saliva cortisol samples. Three additional morning samples determined the cortisol awakening response (CAR). Women with PMDD reported particular high daily life stress and high arousal negative affect (NAhigh) towards stressors during the late luteal phase. High momentary stress levels were linked to lower levels of high arousal positive affect (PAhigh) and to higher levels of rumination in PMDD women compared to controls irrespective of cycle phase. Across groups, more stress was linked to higher levels of low arousal NA (NAlow) and to lower levels of low arousal PA (PAlow). Moreover, PMDD was associated with a delayed CAR peak and a flattened diurnal cortisol slope. While neither group showed cortisol reactivity towards daily life stress directly, high momentary NAhigh and low momentary PA predicted high levels of cortisol across groups, whereas high momentary rumination predicted high cortisol output only in healthy women. In this AA-study we identified important stress-related psychological and endocrinological within-person variability in women with PMDD during daily life. Further research is warranted targeting identified AA-based mechanisms to study their predictive role for the clinical course of PMDD and to provide evidence-based therapeutic options for affected women.
... By facilitating self-regulation of attention and a non-judgmental orientation, MBCT helps to shift attention away from ruminating on the causes and consequences of current and past internal or external states, redirecting the focus toward a non-judgmental perception of the present moment (Li et al. 2022;Mao et al. 2023). Consequently, mindfulness-based interventions effectively reduce daily rumination, improve daily affect, and enhance positive cognitions, such as self-acceptance, in patients with remitted or residual depressive symptoms (e.g., Garland et al. 2015;Timm et al. 2018). ...
... PA and NA were measured using the German version (Krohne et al., 1996) of the Positive and Negative Affect Schedule (PANAS; Watson et al., 1988). In the present study we used the momentary version of the PANAS, which was previously adapted to the use in AA studies (Kuehner et al., 2017;Schultchen et al., 2019;Timm et al., 2018). The PANAS is an instrument to assess momentary PA and NA (Instruction: "This scale consists of a number of words that describe different feelings and emotions. ...
Article
Students are exposed to a variety of stressors that can negatively affect their health and performance. Using an Ambulatory Assessment approach, this study investigated whether and how positive affect (PA) and negative affect (NA) changed in response to real-life stressors in sports students. In addition, the study investigated how physical activity (PhyA) moderated affective reactions to stressors. 62 participants of a German university (m = 23, f = 38, d = 1; age: M = 21.55 years, SD = 2.47) reported their daily stressors, affective states and PhyA (context, intensity and duration) six times per day via smartphone over five days (30 prompts per participants). To test the hypotheses multilevel models were calculated. Stressor context predicted affective reactions. PA was lower and NA was higher when general (financial problems) or academic (exam periods) stressors were reported. General PhyA had a positive effect on sports students affect (higher PA, lower NA). However, when PhyA was performed in exercise classes within their study program and a stressor was reported, PA decreased. The results showed that certain stressors interact negatively with affective states. Furthermore, the results suggested that PhyA, depending on the context where it occurred, may also induce negative affective changes in this target group of sport students. More studies need to examine how PhyA moderates affective reactions to stressors and examine the influences of context specific PhyA (e.g., type of PhyA) in more detail.
... We re-recruited a sample of recurrently depressed patients from a previous study (Timm et al., 2018, N = 78, burst-1) for a follow-up (burst-2). Fifty-four patients from burst-1 agreed to participate in burst-2. ...
Article
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In Major Depressive Disorder, first evidence shows heightened mood-reactivity toward daily events. Related longitudinal studies in remitted patients with recurrent major depression are lacking. Long-term changes in such short-term within-person associations can be analysed via measurement burst designs. Two bursts, separated by approximately 4.4 years, consisted of a baseline session and an Ambulatory Assessment (burst-1: 3 days, burst-2: 5 days). Via smartphone, 54 initially remitted patients with recurrent major depression indicated their negative and positive affect, rumination, self-acceptance, and the occurrence of negative and positive daily events ten times and collected saliva cortisol samples five times per day. In bursts with higher depression levels, patients showed blunted negative affect- and cortisol-reactivity and stronger decreases in positive affect and self-acceptance toward negative daily events, as well as stronger increases in self-acceptance following positive daily events. However, patients with higher depression levels demonstrated stronger ruminative stress-reactivity within bursts. Furthermore, patients with higher depression levels showed an increase of affective stress-reactivity over bursts, such that negative affect more strongly increased and positive affect more strongly decreased following negative daily events over bursts. Following positive daily events, patients with higher depression levels showed stronger decreases in negative affect within bursts and a decrease of self-acceptance-reactivity over bursts. To conclude, measurement burst designs enable to examine intraindividual variability and change of micro-level processes, and possible moderators thereof, potentially providing prognostic information for the course of recurrent major depression.
... Participants were recruited at the university campus of Ludwig-Maximilians-Universität München (LMU Munich) and from the Munich metropolitan area on the web (Facebook and eBay Kleinanzeigen [advertisements in the personal columns]), as well as via flyers and by using the university's email distribution list (covering graduate and undergraduate students). Participants were required to be aged at least 18 years and fluent in German and were excluded if they had practiced mindfulness daily in the past 3 months before the study [41] or had a neurological disorder or a serious disorder for which mindfulness practice may have adverse effects (cardiac function disorders, hypotension, bronchial asthma, migraines, seizure disorders such as epilepsy, attention-deficit/hyperactivity disorder, and dementia). Each participant was informed of the purpose of the study at the recruitment as follows: "The aim of this study is to investigate the effect of a short mindfulness exercise before bedtime on mood, sleep quality, and cognitions. ...
Article
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Background: Repetitive negative thinking (RNT) is a cognitive risk factor for various disorders. Although brief mindfulness-based interventions (MBIs; lasting 20-30 minutes or shorter) are effective tools to reduce RNT, the effect of a minimal (5-minute) MBI remains largely unknown. Objective: We investigated the acute changes in RNT induced by a 10-day minimal MBI (body scan before sleeping) using an ecological momentary assessment (EMA) administered during the MBI training phase. In addition, we examined longer-term effects on the postintervention and 2-month follow-up assessments for questionnaire-based RNT and psychological distress. Methods: A total of 68 participants (community sample, aged 18-55 years; n=58, 85% women) were randomly allocated to either the intervention group (n=35, 51%) or the no-training control group (n=33, 49%). Both groups completed a 10-day EMA phase of RNT, during which only the intervention group performed a daily 5-minute body scan before sleeping. Results: The intervention group showed a significantly larger reduction in questionnaire-based RNT than the control group at the follow-up assessment (for growth-curve modeling analysis [GMA], dGMA=-0.91; P<.001), but this effect was not observed during the EMA phase or at the postintervention assessment. Furthermore, the intervention group showed significantly larger decreases in stress both at the postintervention (dGMA=-0.78; P<.001) and follow-up (dGMA=-0.60; P<.001) assessments than the control group. We found no intervention effects on depressive and anxiety symptoms. Conclusions: A 5-minute body scan before sleeping reduces RNT and stress when continued for at least 10 days; however, the results suggest that this effect only appears with some time lag because no acute changes during and immediately after the intervention emerged for RNT.
... Participants were recruited at the university campus of LMU Munich and from the Munich metropolitan area online (Facebook, eBay Kleinanzeigen), as well as via flyers and using the university's e-mail distribution list (covering graduate and undergraduate students). Participants were required to be at least 18 years old and fluent in German and were excluded if they had practiced mindfulness daily in the past 3 months prior to the study 40 , or had a neurological disorder or a serious disorder for which mindfulness practice may have adverse effects (cardiac function disorders, hypotension, bronchial asthma, migraines, seizure disorders such as epilepsy, attention deficit hyperactivity disorder, and dementia). Each participant was informed of the purpose of the study at the recruitment as follows: "The aim of this study is to investigate the effect of a short mindfulness exercise before bedtime on mood, sleep quality, and cognitions. ...
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BACKGROUND Repetitive negative thinking (RNT) is a cognitive risk factor for various disorders. Although brief mindfulness-based interventions (MBIs; 20-30 minutes or shorter) are effective tools to reduce RNT, the effect of a minimal (five-minute) MBI remains largely unknown. OBJECTIVE We investigated the acute changes in RNT induced by a 10-day minimal MBI (body scan before sleeping) using an ecological momentary assessment (EMA) administered during the MBI training phase. Additionally, we examined longer-term effects on the post-intervention and two-month follow-up assessments for questionnaire-based RNT and psychological distress. METHODS Participants (community sample, 18 to 55 years; 85.3% female) were randomly allocated to either the intervention group (N = 35) or the no-training control group (N = 33). Both groups completed a 10-day EMA assessment phase of RNT, during which only the intervention group performed a daily five-minute body scan before sleeping. RESULTS The intervention group showed a significantly larger reduction in questionnaire-based RNT than the control group at the follow-up assessment (dGMA = -0.91), but this effect was not observed during the EMA phase or at the post-intervention assessment. Furthermore, the intervention group showed significantly larger decreases in stress both at post-intervention (dGMA = -0.78) and follow-up assessment (dGMA = -0.60) than the control group. We found no intervention effects on depressive and anxiety symptoms. CONCLUSIONS A five-minute body scan before sleeping reduces RNT and stress when continued for at least 10 days; however, the results suggest that this effect only appears with some time lag, as no acute changes during and immediately after the intervention emerged for RNT. CLINICALTRIAL NA
... Momentary NA and PA were assessed using 12 items from previous AA studies by our group (e.g. Kuehner, Welz, Reinhard, & Alpers, 2017;Timm et al., 2018). At each assessment, women reported the extent to which they felt several negative (upset, irritated, nervous, listless, down, and bored, α = 0.832 †1 ) and positive (cheerful, energetic, enthusiastic, satisfied, relaxed, and calm, α = 0.708) emotions on a seven-point Likert scale ranging from 1 (not at all) to 7 (very much). ...
Article
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Background The psychological risk factors of premenstrual dysphoric disorder (PMDD) are not fully understood, but initial evidence points to a potential role of unfavorable cognitive emotion regulation (ER-) strategies. Given the symptom cyclicity of PMDD, ambulatory assessment is ideally suited to capture psychological and physiological processes across the menstrual cycle. Our study examines habitual ER-strategies in women with PMDD and their predictive value for the course of mood and basal cortisol across the cycle in affected women. Methods Women with and without PMDD ( n = 61 each) were compared regarding habitual mindfulness, reappraisal, and repetitive negative thinking (RNT). Momentary affect and cortisol output were assessed over two consecutive days per cycle phase (menstrual, follicular, ovulatory, late luteal). Results Women with PMDD reported lower mindfulness, less use of reappraisal and stronger RNT than controls ( p s < 0.035). In women with PMDD, higher mindfulness and reappraisal and lower RNT predicted decreased negative and increased positive affect across the menstrual cycle ( p s < 0.027). However, women using more favorable ER-strategies displayed stronger mood cyclicity, resulting in stronger mood deterioration in the late luteal phase, thereby resembling women with more unfavorable ER-strategies toward the end of the cycle. Lower mindfulness predicted lower cortisol in the menstrual phase. Conclusions Protective ER-strategies seem to be generally linked to better momentary mood in women with PMDD, but do not appear to protect affected women from premenstrual mood deterioration. Habitual mindfulness, in turn, seems to buffer blunted cortisol activity in women with PMDD, especially in the menstrual phase.
... Существуют вмешательства, специально разработанные для профилактики депрессии: когнитивная ремедиация, терапия, основанная на осознанности [37]. Последний метод рекомендуется применять после достижения ремиссии; он весьма эффективен в плане коррекции когнитивных нарушений в данный период [74]. Метод когнитивной ремедиации, в том числе его онлайн-версии, направлен на коррекцию когнитивной дисфункции, используется у пациентов с несколькими депрессивными эпизодами в анамнезе, однако, объем исследований в отношении его эффективности на данный момент недостаточен [67,83]. ...
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Cognitive dysfunction is one of the basic symptoms of endogenous depression, gaining much of the researchers’ interest lately. It is observed at the initial stage, at the peak intensity of depressive symptoms and even after their reduction, which leads to the persistence of residual depressive state. Cognitive impairment during the depressive episode can be detected by objective methods (clinical and neuropsychological), and their subjective importance is being revealed by standardized questionnaires. Depressed patients show lower results in executive functions, working memory, reaction speed, verbal learning, immediate and delayed recall subtests of neuropsychological batteries. There are few pharmacological agents (mostly antidepressants) with well-proven procognitive activity in depression. Besides, some new pharmacological and non-pharmacological approaches for treatment of cognitive impairment in depression have appeared lately and are described in literature as promising.
... Another promising approach is to provide just-in-time interventions on the smartphone between sessions [11]. Also, in clinical trials, intersession interventions were applied [27]. Interestingly, all mentioned approaches have two aspects in common. ...
Article
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The usage of mobile applications in healthcare is gaining popularity in recent years. The ubiquity of a sophisticated mobile appliance that is applicable to sample ecological patient data in real life by acquiring both mental state and environmental data has enabled new possibilities for researchers and healthcare providers. Collecting data using the mentioned approach is often called Ecological Momentary Assessment (EMA) and is characterized by an unidirectional data flow towards the platform provider. A more challenging approach, in turn, is called Ecological Momentary Intervention (EMI). The latter requires a bidirectional data flow in order to enable the possibility of sending feedback to the patients and controlling their experiences through interventions. Although both approaches are established parts of IT-supported treatments in the field of psychology and psychotherapy until now, the so-called intersession process has not been technically supported appropriately yet. Therefore, the Intersession-Online platform was developed in order to (a) assess intersession processes systematically, (b) monitor a patient, and (c) intervene by suppressing negative thoughts concerning the therapy. In this paper, the technical requirements, architecture, and features of the mobile application of the Intersession-Online platform are presented. In this context, the development of a patient data sampling mechanism, which consists of a sophisticated, inter-questionnaire dependent sampling schedule and synchronization strategy is particularly illustrated and discussed. Altogether, the technical challenges will show that a mobile application supporting intersession processes in psychotherapy is an endeavor which requires many considerations. However, on the other, such a mobile application may be the basis for new technical as well as psychological insights.
... The trainings were carried out by supervised cognitive behavioral psychologists or mindfulness-based stress reduction trainers (MBSR trainers had completed a formal 1.5-year professional MBSR training, all trainers had several years of experience in regularly teaching mindfulness skills to patients with mental illness) held once per week (50min, 5 individual sessions) plus audio-guided daily homework (20min/day). The participants included into the present analyses are also included in the paper by Timm et al. (2018) who additionally recruited a set of participants for which no fMRI and respiration measures were taken. Participants were matched for age and sex between intervention groups and randomized to the groups (allocation 1:1 by number list). ...
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Background Depression is related to default mode network (DMN) connectivity and higher respiration pattern variability (RPV). In addition, DMN connectivity and RPV are interrelated and predict a poorer clinical course of depression. The association of RPV and depression might further be boosted by anxiety levels. Aim of the present study was to investigate whether a mindfulness-based training in emotionally challenged remitted depressed participants (rMDD) leads to reduced DMN connectivity and lower RPV, and if RPV interacts with anxiety levels. Methods To challenge participants, sad mood was induced with keywords of personal negative life events in 49 rMDD during fMRI before and after a 4-week mindfulness-based attention training (MBAT) or progressive muscle relaxation. Respiration was measured by means of a built-in respiration belt. Results After both trainings, rMDD showed no significant changes in DMN connectivity. However, MBAT was effective in reducing the RPV which was related to lower anxiety levels especially in high anxious individuals. Conclusions RPV can be influenced by training which may hint to an underlying biological pathway of training effects. Importantly, these effects seem to be associated with anxiety levels. Therefore, respiration focused training might be an important tool assisting the treatment of depression and anxiety.
... In a next step, it could be tested whether addressing such AA characteristics as direct targets in therapy will improve psychological and/or pharmacological interventions for PMDD. Particularly rumination, a transdiagnostic factor in psychopathology, may constitute a promising therapy target, e.g., in the context of mindfulnessbased interventions, which have already proven effective in reducing daily life rumination in patients with recurrent depression [10]. Respective research could also investigate whether changes in momentary mood, rumination, subjective stress reactivity, and/or hypothalamic-pituitary-adrenal axis activation during daily life will mediate intervention effects on clinical symptomatology in PMDD. ...
... The findings highlight the utility of large-scale functional brain networks with roles in cognitive conflict signaling, selfreferential thought, and cognitive flexibility above and beyond self-report and interviewer-rated depressive symptoms in understanding the cognitive-affective sequelae of sadness. Results also indicate the feasibility and importance of considering moment-to-moment interactions between affect and cognition in daily life and encourages their consideration in cognitive control training interventions [82][83][84] as well as in mindfulness-based interventions 85 designed to reduce RNT. ...
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Repetitive negative thinking (RNT) is a maladaptive response to sadness and a transdiagnostic risk-factor. A critical challenge hampering attempts to promote more adaptive responses to sadness is that the between-person characteristics associated with the tendency for RNT remain uncharacterized. From the perspective of the impaired disengagement hypothesis, we examine between-person differences in blood-oxygen-level-dependent (BOLD) functional networks underlying cognitive conflict signaling, self-referential thought, and cognitive flexibility, and the association between sadness and RNT in daily life. We pair functional magnetic resonance imaging with ambulatory assessments deployed 10 times per day over 4 consecutive days measuring momentary sadness and RNT from 58 participants (40 female, mean age = 36.69 years; 29 remitted from a lifetime episode of Major Depression) in a multilevel model. We show that RNT increases following sadness for participants with higher than average between-network connectivity of the default mode network and the fronto-parietal network. We also show that RNT increases following increases in sadness for participants with lower than average between-network connectivity of the fronto-parietal network and the salience network. We also find that flexibility of the salience network’s pattern of connections with brain regions is protective against increases in RNT following sadness. Our findings highlight the importance of functional brain networks implicated in cognitive conflict signaling, self-referential thought, and cognitive flexibility for understanding maladaptive responses to sadness in daily life and provide support for the impaired disengagement hypothesis of RNT.
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Thesis
Premenstrual Dysphoric Disorder (PMDD), outlined as a new diagnostic category in DSM-5, is characterized by key affective and accompanying psychological and physical symptoms during the premenstrual (late luteal) phase of the menstrual cycle, resulting in clinically significant distress and functional impairment. Despite its high prevalence (3%-8% in women of fertile age) and risk of chronic developments, psychological and biological mechanisms underlying PMDD are so far not well understood. Among other factors, a dysregulation of the stress axis is being discussed. The present thesis integrates three substudies from a project using Ambulatory Assessment (AA) with electronic diaries (smartphones) to compare the course of mood, cognitions, and cortisol release in the daily life of women diagnosed with PMDD and healthy control women over the course of the menstrual cycle. AA took place at semi-random time points eight times a day during two consecutive days per cycle phase (menstrual, follicular, ovulatory, and late luteal). In particular, the thesis focused on identifying possible cycle-related within-person changes in affective, cognitive, and endocrinological states and their interrelations as captured in real time and real life. A clinical follow-up was conducted four months after baseline. Study 1 examined the stress-related facets of mood, cognition and cortisol together with basal cortisol activity over the menstrual cycle in women suffering from PMDD and asymptomatic controls. Findings revealed that affected women showed increased subjective stress appraisal and enhanced high arousal negative affect towards daily life stressors particularly in the late luteal phase of the menstrual cycle. Furthermore, PMDD was associated with blunted basal activity of the hypothalamic-pituitary adrenal axis (delayed cortisol awakening response peak, flatter daily cortisol slope) and reduced cortisol reactivity toward periods of enhanced rumination irrespective of menstrual cycle phase. This study revealed substantial cycle-related intraindividual variability in stress appraisal and psychological responses to stress together with blunted basal cortisol activity in PMDD, with the latter similarly observed in other stress-related disorders. Study 2 focused on menstrual cycle-related variations in momentary cognitive and affective daily life states as well as on their time-lagged reciprocal effects in women with PMDD and controls. PMDD women, in contrast to controls, showed higher levels of momentary negative affect and rumination, and lower levels of positive affect and self-acceptance toward the end of the menstrual cycle. Lagged analyses showed stronger reciprocal within-person effects of cognitions and mood in PMDD women, whereby the effect of rumination on subsequent negative affect was limited to the late luteal phase. Stronger prospective associations of daily life cognitions and affective states in PMDD suggests that affected women seem to be more sensitive to detrimental effects of either dimension in a kind of vicious cycle. The study emphasizes the role of cognitions in the context of PMDD suggesting that ruminative thinking might be an important therapeutic target. Study 3 investigated whether AA-characteristics of momentary mood, cognitions, and cortisol, measured across the menstrual cycle at baseline, would predict the four-month clinical symptom course in women with PMDD. Levels of momentary negative and positive affect, rumination, cortisol, and ruminative stress-reactivity improved the prediction of clinical PMDD symptomatology at follow-up after controlling for relevant demographic and clinical risk factors. High negative affect and low cortisol output independently predicted higher PMDD symptom scores and explained more than 15% incremental outcome variance. The identified substantial added value of individual AA-predictors points to the importance to consider such AA-derived phenotypes more systematically in future longitudinal PMDD research. In conclusion, with the application of electronic AA the three studies add to existing knowledge on cycle-related variations in daily life affect, cognitions, and stress hormone release, and their temporal within-person associations in women with PMDD. Moreover, the combination of AA data at the microlevel of daily life experiences with longitudinal data at the macro-level of clinical symptomatology confirmed predictive validity of AA-derived phenotypes for the clinical course of PMDD. Findings may provide a starting point for future intervention research to provide respective evidence-based therapeutic strategies for affected women.
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In the last decade, mental health issues have come to the foreground in academia. Literature surrounding student mental health continues to grow as universities try to implement wellness services and study the mental health of their students. Studies vary greatly in terms of measurement tools, timeframe, sample demographics, as well as the chosen threshold of symptom severity for diagnosis. This review attempts to summarize, contextualize and synthesize papers that pertain to the challenges faced by academic trainees at the undergraduate, graduate and post-graduate level. The evidence for, and against, the common claim of increasing prevalence of mental health issues among students in recent years is discussed. While some studies support this claim, it is difficult to reach a definitive conclusion due to numerous confounding factors such as increased help-seeking behaviour, greater awareness of mental health issues and weak methodology. The prevalence of depression, anxiety, suicidal and self-injurious behaviour, distress and general mental illness diagnoses are discussed. Other issues known to influence mental health, such as sexual assault and bullying, are briefly addressed. Finally, select studies on a few wellness strategies that may improve mental health of trainees, such as mindfulness, are summarised, along with diverse recommendations for individual students, universities, and academia as a whole.
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Rumination, the perseverative thinking about one’s problems and emotions, is a maladaptive response to sadness and a risk factor for the development and course of depression. A critical challenge hampering attempts to promote more adaptive responses to sadness is that the between-person characteristics associated with the tendency to ruminate following depressed mood remain uncharacterized. We examine the importance of between-person differences in blood-oxygen-level dependent (BOLD) functional networks underlying cognitive control for the moment-to-moment association between sadness and rumination in daily life. We pair functional magnetic resonance imaging with ambulatory assessments measuring momentary sadness and rumination deployed 10 times per day over 4 consecutive days from 58 participants (40 female, mean age = 36.69 years; 29 remitted from a lifetime episode of Major Depression). Using a multilevel model, we show that rumination increases following increases in sadness for participants with higher than average between-network connectivity of the default mode network and the fronto-parietal network. We also show that rumination increases following increases in sadness for participants with lower than average between-network connectivity of the fronto- parietal network and the salience network. In addition, we find that the flexibility of the salience network’s pattern of connections with brain regions across time is protective against increases in rumination following sadness. Our findings highlight the importance of the neural correlates of cognitive control for understanding maladaptive responses to sadness and also support the value of large-scale functional connectivity networks for understanding cognitive-affective behaviors as they naturally occur during the course of daily life.
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Background Major depressive disorder (MDD) is characterized by a high risk for relapses and chronic developments. Clinical characteristics such as residual symptoms have been shown to negatively affect the long-term course of MDD. However, it is unclear so far how trait repetitive negative thinking (RNT) as well as cognitive and affective momentary states, the latter experienced during daily-life, affect the long-term course of MDD. Method We followed up 57 remitted depressed (rMDD) individuals six (T2) and 36 (T3) months after baseline. Clinical outcomes were time to relapse, time spent with significant symptoms as a marker of chronicity, and levels of depressive symptoms at T2 and T3. Predictors assessed at baseline included residual symptoms and trait RNT. Furthermore, momentary daily life affect and momentary rumination, and their variation over the day were assessed at baseline using ambulatory assessment (AA). Results In multiple models, residual symptoms and instability of daily-life affect at baseline independently predicted a faster time to relapse, while chronicity was significantly predicted by trait RNT. Multilevel models revealed that depressive symptom levels during follow-up were predicted by baseline residual symptom levels and by instability of daily-life rumination. Both instability features were linked to a higher number of anamnestic MDD episodes. Conclusions Our findings indicate that trait RNT, but also affective and cognitive processes during daily life impact the longer-term course of MDD. Future longitudinal research on the role of respective AA-phenotypes as potential transdiagnostic course-modifiers is warranted.
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Recent theory suggests that positive psychological processes integral to health may be energized through the self-reinforcing dynamics of an upward spiral to counter emotion dysregulation. The present study examined positive emotion–cognition interactions among individuals in partial remission from depression who had been randomly assigned to treatment with mindfulness-based cognitive therapy (MBCT; n = 64) or a waitlist control condition (n = 66). We hypothesized that MBCT stimulates upward spirals by increasing positive affect and positive cognition. Experience sampling assessed changes in affect and cognition during 6 days before and after treatment, which were analyzed with a series of multilevel and autoregressive latent trajectory models. Findings suggest that MBCT was associated with significant increases in trait positive affect and momentary positive cognition, which were preserved through autoregressive and cross-lagged effects driven by global emotional tone. Findings suggest that daily positive affect and cognition are maintained by an upward spiral that might be promoted by mindfulness training.
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The investigation of treatment mechanisms in randomized controlled trials has considerable clinical and theoretical relevance. Despite the empirical support for the effect of mindfulness-based cognitive therapy (MBCT) in the treatment of recurrent major depressive disorder (MDD), the specific mechanisms by which MBCT leads to therapeutic change remain unclear. By means of a systematic review we evaluate how the field is progressing in its empirical investigation of mechanisms of change in MBCT for recurrent MDD. To identify relevant studies, a systematic search was conducted. Studies were coded and ranked for quality. The search produced 476 articles, of which 23 were included. In line with the theoretical premise, 12 studies found that alterations in mindfulness, rumination, worry, compassion, or meta-awareness were associated with, predicted or mediated MBCT's effect on treatment outcome. In addition, preliminary studies indicated that alterations in attention, memory specificity, self-discrepancy, emotional reactivity and momentary positive and negative affect might play a role in how MBCT exerts its clinical effects. The results suggest that MBCT could work through some of the MBCT model's theoretically predicted mechanisms. However, there is a need for more rigorous designs that can assess greater levels of causal specificity. Copyright © 2015. Published by Elsevier Ltd.
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The scientific interest in meditation and mindfulness practice has recently seen an unprecedented surge. After an initial phase of presenting beneficial effects of mindfulness practice in various domains, research is now seeking to unravel the underlying psychological and neurophysiological mechanisms. Advances in understanding these processes are required for improving and fine-tuning mindfulness-based interventions that target specific conditions such as eating disorders or attention deficit hyperactivity disorders. This review presents a theoretical framework that emphasizes the central role of attentional control mechanisms in the development of mindfulness skills. It discusses the phenomenological level of experience during meditation, the different attentional functions that are involved, and relates these to the brain networks that subserve these functions. On the basis of currently available empirical evidence specific processes as to how attention exerts its positive influence are considered and it is concluded that meditation practice appears to positively impact attentional functions by improving resource allocation processes. As a result, attentional resources are allocated more fully during early processing phases which subsequently enhance further processing. Neural changes resulting from a pure form of mindfulness practice that is central to most mindfulness programs are considered from the perspective that they constitute a useful reference point for future research. Furthermore, possible interrelations between the improvement of attentional control and emotion regulation skills are discussed.
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Received: January 29, 2017 Accepted: June 29, 2017 Published online: September 14, 2017 Issue release date: October 2017
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